Taylor Pamela J
Department of Psychological Medicine, Wales College of Medicine, Cardiff University, Cardiff CF14 4XN, UK.
Behav Sci Law. 2006;24(3):313-31. doi: 10.1002/bsl.686.
Delusional disorders are rare, but psychoses with prominent and persistent delusions are less so. A small but significant association between psychosis and violence is often mediated by delusions in such illnesses. Traditionally, delusions have been viewed as "incorrigible", but there is evidence that they change over time. During development of a scale for measuring delusions, it was found that people who acted violently on their "most important" delusion were more likely to have modified that belief after a mild form of challenge to it. When cognitive-behaviour therapy (CBT) is used for schizophrenia, attempts to modify psychotic symptoms are generally included. Could studies of CBT provide further information about possible risks of social interactions about delusions?In the UK, 2000 people with schizophrenia have been in randomized controlled trials of CBT with a goal of symptom modification. These studies were examined for evidence of violence during the treatment. There was none. Given the period prevalence of violence among people with psychosis, this is surprising. In these studies, however, both challenge to delusions and change in them was minimal and in the context of a safe clinical relationship. Challenge to delusions may, however, occur in a variety of social situations. There are no systematic data on lay challenge to them, but it seems likely that some in the sufferer's social circle will do so vigorously. Relatives, friends, and acquaintances are the people most vulnerable to the most serious violence by someone with psychosis. Study of how people interact in these circumstances and whether their interactions are relevant to modification of delusions would be worthwhile. Could those close to a sufferer learn skills for responding to such pathological beliefs that could be protective against violence, perhaps derived from the principles of CBT?
妄想障碍较为罕见，但具有突出且持续妄想的精神病则相对没那么罕见。在这类疾病中，精神病与暴力行为之间存在一种虽小但显著的关联，这种关联通常由妄想介导。传统上，妄想被视为“无法纠正的”，但有证据表明它们会随时间而改变。在制定一个测量妄想的量表时，发现那些基于其“最重要”的妄想而实施暴力行为的人，在对该妄想进行轻度挑战后更有可能改变那种信念。当认知行为疗法（CBT）用于治疗精神分裂症时，通常会尝试改变精神病性症状。关于CBT的研究能否提供更多有关妄想在社交互动中可能存在的风险的信息呢？在英国，2000名精神分裂症患者参与了旨在改善症状的CBT随机对照试验。对这些研究进行了检查，以寻找治疗期间暴力行为的证据。结果未发现此类证据。鉴于精神病患者中暴力行为的期间患病率，这一结果令人惊讶。然而，在这些研究中，对妄想的挑战以及妄想的改变都微乎其微，且是在安全的临床关系背景下发生的。然而，对妄想的挑战可能会在各种社交场合出现。目前尚无关于外行人对妄想提出挑战的系统数据，但似乎患者社交圈子中的一些人会大力这样做。亲属、朋友和熟人是最容易受到精神病患者最严重暴力侵害的人群。研究人们在这些情况下如何互动，以及他们的互动是否与妄想的改变相关，将是很有价值的。精神病患者身边的人能否学习一些应对此类病态信念的技巧，这些技巧或许源自CBT的原则，从而预防暴力行为呢？
